NURSED TO HEALTH: Pregnant women especially at risk when it comes to zika

When people think of the Zika virus, they usually think of mosquitoes. Their bite is, after all, the primary mode of transmission of the disease. However, it’s important to know that this virus, first reported in the U.S. in 2015, can also be transmitted from mother to fetus during pregnancy, as well as through sexual intercourse.

The incubation period once bitten is 2-14 days, and only about one in four adults has any noticeable symptoms. The symptoms of Zika infection include low-grade fever (less than 100.4 degrees Fahrenheit), a flat, red rash over the trunk, face, extremities, palms of hands and soles of feet, as well as pain in the joints of the hands and feet and redness of the eyes (conjunctiva). Most adults recover within a week and suffer no long-term consequences, according to the Centers for Disease Control.

But women who contract Zika during pregnancy carry the risk of passing the virus to their unborn fetuses. During pregnancy, the Zika virus can cross the placenta and destroy brain cells of developing fetuses, impairing normal brain development. This may lead to a condition called microcephaly, which results in a smaller-than-normal brain and head on the infant and cognitive deficiencies.

Congenital anomalies such as microcephaly were found in 10 to 15 percent of the infants of mothers confirmed to have contracted Zika during pregnancy. Although research is ongoing, infection in the first trimester or early second trimester (before 20 weeks) is the most vulnerable timeframe, according to the CDC.

Prevention of Zika infection is of paramount importance for women of reproductive age who are considering a pregnancy. Avoidance of travel to any country or region with a known Zika outbreak is recommended. At this time, there are no areas within the United States with active Zika outbreaks, and only Brownsville, Texas, is considered a cautionary zone. However, most countries in Central and South America are in the recommended no-travel zone publicized by the CDC.

Mosquito protection measures must be used whenever outdoors, regardless of the time of day or night. This includes the use of approved insect repellant (including DEET and permethrin) for use on skin and/or clothes. Individuals should wear long-sleeve shirts and pants if possible and try to avoid any areas of exposed skin.

If women work outdoors (or if their partners also work outdoors), they should consider asking for temporary transfer to indoor work to reduce the risk of insect bites. Avoidance of direct contact of blood and other body fluids should be undertaken, especially if the person works in health care. If either partner reports symptoms similar to those caused by Zika, they should both consider blood testing to confirm the presence of the virus and, if positive, should delay trying to conceive for at least eight weeks for women and six months for men. If both are asymptomatic, the Centers for Disease Control recommends waiting at least eight weeks from last possible exposure before attempting to conceive. Once pregnant, the couple is advised to use condoms during sexual intercourse to avoid infection from this route during the pregnancy.

Here is a case study of a local individual concerned about contracting Zika while traveling:

JAIMIE

Jaimie, 32, was getting married in a few months. She and her fiancée hoped to begin planning a pregnancy soon after they married, but were afraid of contracting Zika and having a baby with a brain abnormality. Jaimie was a nurse at a local hospital and her fiancée worked in business but also enjoyed playing golf.

Jaimie made an appointment with her nurse practitioner to discuss her pregnancy plans. The nurse practitioner took her history. She asked about her honeymoon plans and discovered the couple hoped to go on a Caribbean cruise in the summer, after the wedding. Neither she nor her fiancée reported any recent flu-like symptoms and, although she was a nurse, Jaimie said she was very careful when around blood and other body fluids of her patients.

Based on the history obtained, the nurse practitioner advised Jaimie to reconsider her honeymoon plans and proposed the pair consider a visit to another region instead. She encouraged Jaimie to remain diligent at work in handling patient bodily fluids.

She went even further, recommending that both Jaimie and her fiancée avoid going outdoors without adequate skin and clothing protection, and that her fiancée play golf only during the middle of the day, when mosquitoes are less likely to be present. If either noticed any flu-like symptoms, they were advised to call their medical providers right away.

Nursed to Health is an occasional feature in The Florida Times-Union in which Jacksonville University Keigwin School of Nursing faculty discuss symptoms, diagnoses and treatments based on actual and composites of patient cases handled by instructors, students and alumni of JU’s local training programs. Today’s column is by Hilary Morgan, Assistant Professor and Director of the Nursing Doctoral Program in JU’s Brooks Rehabilitation College of Healthcare Sciences.

Names and specific medical information in Nursed to Health have been changed to protect private health information, and any similarity is coincidental. For more information about JU’s Keigwin School of Nursing, visit www.ju.edu/chs/nursing. Readers with specific questions regarding their own health concerns should seek the advice of their healthcare provider.